Depression, substance use, and sexual orientation as cofactors in HIV-1 infected men: cross-cultural comparisons.

The co-occurrence of major depression in medical populations has been the subject of much controversy in the past decade. Although some investigators have suggested that reports of an increased prevalence of depression may, in part, be due to misclassification based on physician reliance on self-report methods (Perez-Stable et al. 1990) or on failure to adjust for symptoms induced by physical illness (Plumb and Holland 1977), most studies have suggested that the prevalence of depression is high, although often undetected by the primary care physician (Perez-Stable et al. 1990; Schulberg et al. 1985). Schulberg and colleagues (1985) state that it is unclear whether this oversight reflects true limitations in the physician's diagnostic acumen, his/her lack of concern for social implications, or whether it is an artifact of existing classification procedures. Regardless of the reasons for its underreporting, the detection and treatment of depression is crucial, especially for medically ill patients, because depressive disorders may adversely affect survival, length of hospital stay, compliance with therapy, ability to care for oneself, and quality of life (Schulberg et al. 1985).